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I:E ratio and FL questions
#11
RE: I:E ratio and FL questions
I also think a higher min pressure should help. start with the min 8 epr 3 setting your chart showed and raise the min 1cm in a few days to 9 epr3 for a few days and see if it improves. I would lift the max to be out of the way. I wouldn't be in a rush for a new machine. You can shape your TV and I:E with bpap if needed, but it may not be your problem. An increase in pressure may resolve it enough.
mask fit http://www.apneaboard.com/wiki/index.php...ask_Primer
For auto-cpap, from machine data or software. You can set the min pressure 1 or 2cm below 95%. Or clinicians commonly use the maximum or 95% pressure for fixed pressure CPAP, this can also be used for min pressure.
https://aasm.org/resources/practiceparam...rating.pdf
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#12
RE: I:E ratio and FL questions
I agree with both your analysis and ajack's suggestion. Pressure support is how respiratory effort is really made easier. Pressure is what opens the airway. So once your airway is unobstructed, pressure support like the Vauto delivers is ideal. Increased minimum pressure as suggested by ajack can further "inflate" the airway and help reduce restriction/limitation. Both are good approaches. Since you have the CPAP now, the higher pressure is the least expensive and most available option. If you don't achieve your goals with that, then consider the bilevel that can offer more pressure support.
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#13
RE: I:E ratio and FL questions
At the start of my therapy, I had a pressure range of 5 to 20. Median IP was as low as 6.9 and as high as 9.3, with max generally 11 to 12. The FL numbers and the breath-by-breath flow-rate shapes were the same then as now, even at the higher pressures. This suggests to me that I’d need to go higher still to open the nasal passages.

Even so, I might try inching up, just to see what happens, though not until my chest feels better. I’m inclined to stick with a fixed pressure for now, since changes in pressure seem to contribute to unrestful sleep.

Appreciate all your good help, ajack and Sleeprider! It really helps to know there are several options open to me.
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#14
RE: I:E ratio and FL questions
It's possibly not opening your nasal passage, but the min pressure is providing an air splint for your throat, to keep it open.
This video is worth watching
https://www.youtube.com/watch?v=-gie2dhqP2c&t=158s
mask fit http://www.apneaboard.com/wiki/index.php...ask_Primer
For auto-cpap, from machine data or software. You can set the min pressure 1 or 2cm below 95%. Or clinicians commonly use the maximum or 95% pressure for fixed pressure CPAP, this can also be used for min pressure.
https://aasm.org/resources/practiceparam...rating.pdf
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#15
RE: I:E ratio and FL questions
Hi Dormeo,

I have seen exactly same pattern of flow, couple days ago, as I am reading a lot  medical sites, trying about issues with CPAP. Unfortunely I canot find it, but it stated, that it is expiratory muscle flutter. I found another article describing something similar. 

https://www.pftforum.com/blog/sawtooth-p...lume-loop/

If I had shorter exp. time, then insp time I woud definitly seek answers from professionals to rule out some underlying cause.

Incidentally, on Monday I have seen new Respiratory Tech. (experienced in ICU with respirators) and to adress isuues was having with CPAT I was put on single pressure 7 and now I feel so much better. Also Titration study for CPAP/Bilevel/ASV is being arranged.

Wish you well

Mila
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#16
RE: I:E ratio and FL questions
Thanks for the informative links, ajack and Mila.

It’s certainly possible that my FLs come from my throat, ajack, though I wonder whether the nasal passages are the likelier culprit. (I’m a side-sleeper, seldom snore, have a normal BMI, and saw no difference using a Dr. Dakota collar for some weeks. I do have an allergy to dust mites, a drippy nose, and post-nasal drip.)

All that said, I’ve decided to go ahead and start inching my min pressure upward, even without knowing what the chest problem is. It’d be wonderful if I could resolve the FLs this way and get better rest.

Mila, I generally observe two peaks in the flow rate for inhalation, rather than a sawtooth pattern, and Sleeprider thinks the oscillations at the the end of exhalation are probably caused by my heartbeat. But I’m definitely going to bring this up when I see my doctor about my chest discomfort.

And Mila, I’m glad to hear you’re feeling better, and I hope the upcoming titration will lead to improvements in your therapy and sleep.
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#17
RE: I:E ratio and FL questions
Hi,  

In the middle of this article is drawing and explanation of different inspiratory flow shapes.


https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4688581/


Attached Files Thumbnail(s)
   
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#18
RE: I:E ratio and FL questions
Thanks, Mila. The whole article was interesting!
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#19
RE: I:E ratio and FL questions
(03-09-2019, 03:49 PM)Dormeo Wrote: Thanks for the informative links, ajack and Mila.

It’s certainly possible that my FLs come from my throat, ajack, though I wonder whether the nasal passages are the likelier culprit. (I’m a side-sleeper, seldom snore, have a normal BMI, and saw no difference using a Dr. Dakota collar for some weeks.  I do have an allergy to dust mites, a drippy nose, and post-nasal drip.)

All that said, I’ve decided to go ahead and start inching my min pressure upward, even without knowing what the chest problem is. It’d be wonderful if I could resolve the FLs this way and get better rest.

Mila, I generally observe two peaks in the flow rate for inhalation, rather than a sawtooth pattern, and Sleeprider thinks the oscillations at the the end of exhalation are probably caused by my heartbeat. But I’m definitely going to bring this up when I see my doctor about my chest discomfort.

And Mila, I’m glad to hear you’re feeling better, and I hope the upcoming titration will lead to improvements in your therapy and sleep.

As mila suggested, nothing beats a good doctor and titration. As she is Canadian and I'm aussie, we have cheap medical. I don't know what your insurance is like, I know that some in the US are financially forced to self treat. With a very high co-pay for a titration.
I would have thought if it was your nose, you would naturally switch to mouth breathing. Even while awake this can happen with a crook nose.
mask fit http://www.apneaboard.com/wiki/index.php...ask_Primer
For auto-cpap, from machine data or software. You can set the min pressure 1 or 2cm below 95%. Or clinicians commonly use the maximum or 95% pressure for fixed pressure CPAP, this can also be used for min pressure.
https://aasm.org/resources/practiceparam...rating.pdf
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